What Is Heart Disease
Heart disease includes several kinds of problems that affect your heart. The term cardiovascular disease is similar but includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.
Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke.
Hardening of the arteries can happen in other parts of the body too. In the legs and feet, its called peripheral arterial disease, or PAD. PAD is often the first sign that a person with diabetes has cardiovascular disease.
Diabetes Mellitus Is A Common Condition Affecting Around 7% Of The Uk Population It Is The Most Common Cause Of Chronic Kidney Disease Responsible For Around A Third Of People Needing Kidney Replacement Therapy
Diabetes is a serious condition where the glucose levels in your blood are too high. You get glucose from food and drink and it is moved from the blood to your cells by a hormone called insulin which is made in the pancreas. There are two main types of diabetes:
- Type 1 usually starts in childhood or adolescence, although it can occur at any age. People with type 1 diabetes cant make any insulin themselves as their bodies attack the cells in the pancreas that normally make it
- Type 2 usually starts in middle age although it is becoming increasingly common in younger people. People with type 2 diabetes produce some insulin but it is not effective and over time not enough is made.
In both types of diabetes, because the glucose cant get into your cells, it builds up in the blood. If left untreated, high glucose levels can cause serious damage to your body, including your eyes, heart, feet and kidneys.
Whichever type of DM you have, even when diabetes is controlled, the disease can lead to kidney problems. Fortunately, most people with diabetes do not develop a kidney problem that is severe enough to progress to end-stage renal disease , requiring dialysis and/or a transplant.
Managing Blood Sugar Levels
This is crucial for lowering the risk of diabetes complications, such as kidney disease, cardiovascular disease, and diabetic neuropathy, which affects the nervous system.
These conditions, too, can lead to further complications. Managing blood sugar levels can also help prevent these from developing.
If diabetic nephropathy progresses to ESRD, a person will need either dialysis or a kidney transplant. They will usually need dialysis for the rest of their life or until a kidney transplant is available.
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The Connection Between Diabetes Kidney Disease And High Blood Pressure
It’s a triple health threat faced by tens of millions of Americans. But few think about it until they’re forced to.
Even then, the interplay between diabetes, high blood pressure and kidney disease can be a challenge for people to grasp. But doctors say having an understanding is key for anybody who wants to reduce their risk or already has the conditions, or who helps a family member with them.
It’s especially important for people who could benefit from new medications but face barriers slowing their use.
More than 34 million people, or 10.5% of the U.S. population, have diabetes, according to the Centers for Disease Control and Prevention. Most cases are Type 2, or adult-onset. When someone has diabetes, they can’t make or use insulin as well as they should. That causes blood sugar to rise, which leads to various complications throughout the body.
Dr. Vivek Bhalla, an associate professor of medicine and nephrology at Stanford University School of Medicine in California, summed it up: “Diabetes can affect small blood vessels. And that can result in hypertension. And that can also result in kidney disease.”
It can be a vicious cycle, said Bhalla, past chair of the American Heart Association’s Council on the Kidney in Cardiovascular Disease.
Much of that cycle goes on invisibly, Bhalla said.
A new generation of diabetes drugs could radically improve that.
Rangaswami said that highlights the need for doctors to better communicate with one another.
Kidney Disease And Water Retention
The main responsibility of the kidney is to filter the blood and help maintain fluid levels in the body.
However, with kidney patients, water retention occurs usually. Because the kidney does not work properly, they cannot remove waste material including fluids and sodium from the body and causes water retention disease.
People with kidney disease may notice faster heartbeat and swelling in the lower limbs, hands, or face.
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Combination Therapy With Ace Inhibitors And A2rb’s
ACE inhibitors and A2RBs have antiproteinuric properties which are independent of their blood pressure lowering effect. Used in combination, these agents can produce more potent reductions in proteinuria. However, there have been concerns about potential adverse effects such as renal failure, hyperkalaemia and hypotension out-weighting these benefits in all except those with refractory proteinuria.
The Link Between Diabetes And Renal Failure
Those who want to know that how can diabetes lead to renal failure, are advised to know the impact of it on a persons body. Diabetes is a health disorder in which our body doesnt make enough insulin. Insulin is that hormone which regulates the amount of sugar in a persons blood. With the decrease in the level of insulin, the blood sugar level of a person starts rising. High blood sugar level or diabetes causes damage to the small blood vessels in the kidneys. This damage to small blood vessels affects the filtration function of the kidneys.
This dysfunction of kidneys let the fluid, toxins, chemicals, and waste to build up in blood. Hence diabetes can let a person face acute renal failure sign and symptoms. Not only this, but diabetes can also cause damage to the nerves in a persons body. This can cause the urine to back up inside the kidneys which can turn into an infection.
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The Effects Of Kidney Disease
Over time, high blood sugar levels can damage tiny blood vessels in your kidneys, which means they cannot filter your blood properly.
As a result, tiny particles of protein spill into the urine this is called microalbuminuria. As kidney disease progresses, larger amounts of protein spill into the urine this condition is called proteinuria.
As kidney disease progresses, waste products start to build up in your blood because your body can’t get rid of them. If left untreated, your kidneys will eventually fail and dialysis or a kidney transplant will be required.
Diabetes can also affect the nerves that tell you when your bladder is full. The pressure from a full bladder can damage the kidneys. If urine remains in the bladder for a long time, it can increase your risk of developing a urinary tract infection, which can spread to the bladder.
The Mechanism Is Unknown
It is clear that diabetes can lead to kidney disease, but just why high blood sugars should damage the glomeruli is unclear. High blood pressure is a known risk factor for kidney disease and people with diabetes are prone to hypertension. The renin-angiotensin system â which helps regulate blood pressure â is also thought to be involved in the development of diabetic nephropathy.Other risk factors include cigarette smoking and family history. Diabetic nephropathy progresses steadily despite medical intervention. However, treatment can significantly slow the rate of damage.
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Heart And Blood Vessels
Heart disease and blood vessel disease are common problems for many people who dont have their diabetes under control. You’re at least twice as likely to have heart problems and strokes as people who dont have the condition.
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Blood vessel damage or nerve damage may also cause foot problems that, in rare cases, can lead to amputations. People with diabetes are ten times likelier to have their toes and feet removed than those without the disease.
Symptoms: You might not notice warning signs until you have a heart attack or stroke. Problems with large blood vessels in your legs can cause leg cramps, changes in skin color, and less sensation.
The good news: Many studies show that controlling your diabetes through medication, diet and exercise can help you avoid these problems, or stop them from getting worse if you have them.
How Can I Tell If I Have Diabetic Kidney Disease
Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.
Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.
You should get tested every year for kidney disease if you
- have had type 1 diabetes for more than 5 years
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Testing For Heart Disease
Your blood pressure, cholesterol levels, and weight will help your doctor understand your overall risk for heart disease. Your doctor may also recommend other tests to check your heart health, which could include:
- An electrocardiogram to measure your hearts electrical activity. Your heartbeat is the result of an electrical impulse traveling through your heart.
- An echocardiogram to examine how thick your heart muscle is and how well your heart pumps.
- An exercise stress test to see how well your heart functions when its working hard.
Kidney Disease Leads To Coronary Artery
With kidney patients, there is a disturbance in sugar and fat metabolism as well as an increase in blood pressure, those are increased the risk of coronary heart disease.
Besides, kidney disease also affects the coronary system through two mechanisms:
Atherosclerosis in kidney patients is motivated and manifested by an increase in plaque size, calcification, inflammation, and thickening of the mediastinum, which is distinct from atheroma.
It is these changes that can make the characteristics of coronary injury in patients with end-stage renal failure more severe.
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Diabetes And Chronic Kidney Disease
If you have diabetes, ask your doctor about kidney disease.
Chronic kidney disease often develops slowly and with few symptoms. Many people dont realize they have CKD until its advanced and they need dialysis or a kidney transplant to survive.
If you have diabetes, get your kidneys checked regularly, which is done by your doctor with simple blood and urine tests. Regular testing is your best chance for identifying CKD early if you do develop it. Early treatment is most effective and can help prevent additional health problems.
CKD is common in people with diabetes. Approximately 1 in 3 adults with diabetes has CKD. Both type 1 and type 2 diabetes can cause kidney disease.
- Kidney diseases are the 9th leading cause of death in the United States.
- Approximately 1 in 3 adults with diabetes has CKD.
- Every 24 hours, 170 people with diabetes begin treatment for kidney failure.
Stages Clinical Features And Clinical Course
Diabetic nephropathy has been didactically categorized into stages based on the values of urinary albumin excretion : microalbuminuria and macroalbuminuria. The cutoff values adopted by the American Diabetes Association for the diagnosis of micro- and macroalbuminuria, as well as the main clinical features of each stage, are depicted in . There is accumulating evidence suggesting that the risk for developing diabetic nephropathy and cardiovascular disease starts when UAE values are still within the normoalbuminuric range. Progression to micro- or macroalbuminuria was more frequent in patients with type 2 diabetes with baseline UAE above the median . After 10 years of follow-up, the risk of diabetic nephropathy was 29 times greater in patients with type 2 diabetes with UAE values > 10 g/min . The same was true for patients with type 1 diabetes . This favors the concept that the risk associated with UAE is a continuum, as is the case with blood pressure levels . Possibly, values of UAE lower than those currently used for microalbuminuria diagnosis should be established.
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What Will Happen If My Kidneys Have Been Damaged
First, the doctor needs to find out if your diabetes has caused the injury. Other diseases can cause kidney damage. Your kidneys will work better and last longer if you:
- Control your diabetes
- Get treatment for urinary tract infections
- Correct any problems in your urinary system
- Avoid any medicines that may damage the kidneys
If no other problems are found, your doctor will try to keep your kidneys working as long as possible. The use of high blood pressure medicines called angiotensin converting enzyme inhibitors has been shown to help slow the loss of kidney function.
Risk Factors And Pathogenesis
Diabetic nephropathy develops in, at most, 40% of patients with diabetes, even when high glucose levels are maintained for long periods of time. This observation raised the concept that a subset of patients have an increased susceptibility to diabetic nephropathy. Furthermore, epidemiological and familial studies have demonstrated that genetic susceptibility contributes to the development of diabetic nephropathy in patients with both type 1 and type 2 diabetes. The main potentially modifiable diabetic nephropathy initiation and progression factors in susceptible individuals are sustained hyperglycemia and hypertension . Other putative risk factors are glomerular hyperfiltration , smoking , dyslipidemia , proteinuria levels , and dietary factors, such as the amount and source of protein and fat in the diet.
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Nutritional Recommendations For Diabetic Patients With Ckd
As diabetic patients experience progressive loss of renal function, nutritional issues become more complex. On one hand, in addition to the existing limitations associated with DM, specific restrictions are needed for patients with CKD, including restriction of protein, phosphorus, and potassium. On the other hand, patients with worsening uremic syndrome have a higher risk of protein-calorie malnutrition that needs to be identified and addressed by the medical team. Thus, nutritional monitoring is of utmost importance in this patient population. Standardized protocols should be avoided, and individualized care and monitoring of patients should be implemented.
Initially, patients should be evaluated based on their standard intake and clinical laboratory results. Then, a nutritional counseling plan should be designed based on nutritional guidelines that aid in the development of appropriate diets for patients, always considering individual needs.
For the population of diabetic patients with CKD in the non-dialytic phase, the composition of macronutrients in the nutritional plan is described in Table
Table 1 Dietary plan macronutrient composition for DKD in the non-dialysis stage.
One method that can be used to control blood glucose in these patients is carbohydrate counting, in which grams of this macronutrient obtained from meals are recorded throughout the day. This method is efficient in food control and the use of insulin, and its orientation should be individualized.
Risk Factors For Diabetic Nephropathy
There are many factors that can increase your risk of developing diabetic nephropathy. These include:
- the length of time that you have had diabetes
- having high blood glucose levels
- having high blood pressure
- being overweight or obese and
Your risk is also higher if you have other problems related to your diabetes. These include diabetic retinopathy or diabetic neuropathy.
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Kidney Disease Can Lead To Depression
Depression is a common disorder among people living with chronic conditions like kidney patients.
Moreover, depression is predictive evidence of a rapid decline in kidney function. People with severe depression have a higher risk of kidney disease than the general population.
Symptoms of depression in kidney patient include:
- Having sleeping troubles
Control Your Blood Pressure
Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.
Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in pril or sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.
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Questions To Ask Your Doctor About Ckd
If you have high blood pressure or diabetes, its important to start or continue a dialogue with your doctor about your risk for CKD. Here are some questions you may want to ask, depending on your current kidney disease status.
1. Am I at risk for kidney damage if I have high blood pressure?
High blood pressure can damage blood vessels in your kidneys. If youve had uncontrolled high blood pressure for some time, theres a good chance youre at an elevated risk for CKD and may benefit from kidney function screening.
2. Am I at risk for kidney damage if I have diabetes?
Diabetes is the leading cause of CKD. Depending on how well controlled your blood sugar levels have been, you may have an increased risk of kidney damage if you have type 1 or type 2 diabetes. Talk to your doctor about ways to keep your kidneys healthy and whether you should get tested for CKD.
3. Should I have my kidney function tested?
A common test for kidney function measures blood levels of creatinine a normal waste product from muscle breakdown and uses this number along with other data to calculate an estimated glomerular filtration rate . Other tests to screen for and evaluate kidney disease look at levels of protein and blood in urine.
4. Do I have CKD?
5. What is my kidney function number?
Knowing your kidney function level and the stage of your CKD can help you and your doctor evaluate whether your current treatment strategy is working as well as it could.
6. Do I have protein in my urine?